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You've heard of massage for pain but what about rolfing or myofascial release? These and other touch therapies are getting credit for lowering stress and speeding healing. Could they help you? Listen in to find out more.

We’re joined by Dr. Thomas Findley, a physician specializing in physical medicine and rehabilitation, Miguel Angel Diego, research associate at the Touch Research Institute, and Aaron LeBauer, a licensed massage and bodywork therapist.

As always, our expert guests answer questions from the audience.

Announcer:

The opinions expressed on this webcast are solely the views of our guests. They are not necessarily the views of HealthTalk, our sponsors or any outside organization. And, as always, please consult your own physician for the medical advice most appropriate for you.

Judy Foreman:

Hello and welcome to HealthTalk Live [HealthTalk Live has been renamed Health Now with Judy Foreman]. I’m your host, Judy Foreman.

You’ve heard of massage for pain, but what about Rolfing or myofascial release? These and other touch therapies are getting credit for lowering stress and speeding healing. Could they help you? Tonight we talk to three experts about the benefits of touch.

I’m pleased to welcome Dr. Thomas Findley, a physician specializing in physical medicine and rehabilitation. He is director for research at the Northern New Jersey Pain and Rehabilitation Center and associate director of the Center for Healthcare Knowledge Management, and he is also head of the Rolf Institute in Denver.

Dr. Thomas Findley, welcome to HealthTalk Live.

Dr. Thomas Findley:

Thank you very much.

Judy:

You’re very welcome.

I’m also pleased to welcome Miguel Diego, Research Assistant Professor of Pediatrics at the University of Miami School of Medicine. He has worked as a research associate at the Touch Research Institute in Miami and has a Ph.D. in developmental psychobiology. Miguel Diego, welcome to HealthTalk Live.

Dr. Miguel Angel Diego:

Thank you for having me.

Judy:

And last but not least I’d like to introduce Aaron LeBauer, a licensed massage and body work therapist based in Greensboro, North Carolina. Aaron LeBauer is currently working toward his Doctor of Physical Therapy at Elon University in Greensboro.

Aaron LeBauer, thanks for joining us.

Mr. Aaron LeBauer:

Hi, Judy. Thank you for having me.

Judy:

Well, I’d like to start with you, Dr. Findley, by asking you to define touch, not just as we all subjectively know it but from a neurological perspective. In terms of our nervous systems, what exactly is touch?

Dr. Findley:

Well, to describe it in very concrete terms, it is stimulation of the mechanoreceptors in our skin, the fascial layers under the skin and in the muscles.

Judy:

Okay.

Dr. Findley:

There are nerve receptors that are specialized to feel the sensation of touch, and those signals then go into our brain, which proceeds to interpret that in multiple different ways.

Judy:

So these receptors are totally separate from, say, receptors for heat or receptors for pain?

Dr. Findley:

That’s correct.

Judy:

And we’re all born with these. And do their numbers increase as we get older, or are we born with all the touch receptors we’re going to have?

Dr. Findley:

We don’t know the answer to that yet. That’s why we’re studying it, to find out. Because they haven’t been concerned about that for a very long period of time, mostly because the sensations of pain and heat and when you cut your skin, those are things that we’ve been concerned about because they can cause some major medical problems. Touch receptors, on the other hand, have been kind of ignored. They’re the kind of thing that keeps us healthy and medicine hasn’t paid so much attention to that.

Judy:

I’m sure that’s true. Miguel Diego, I’d like to ask you, from you your knowledge of the development and psychobiology of infants, how important is being touched in terms of physical and psychological development? Does being touched in a loving, gentle way actually have a documentable effect on the body and the mind?

Dr. Diego:

Touch is extremely important for normal development. It’s the very first sense that develops, and it’s active way before we even get into the third trimester. Babies even as young as the third trimester are able to feel sensations in their body. And one of the important things that happens after the baby is born is that touch is one of the ways that bonding gets established between the mother and the infant, and it establishes positive emotional relationships between them. There is some research that was conducted in the 50s that established how important touch and particularly certain types of touch was for the development of normal emotional behavior, in that babies of different animals were exposed to either an environment where they were deprived of touch or they had experiences that were rich in touch, such as a teddy bear that was furry versus a model that was all wire and sticks. And what they found was that the attachment that the babies developed toward the more realistic model helped them in their social development.

Judy:

I remember those studies. Who did those?

Dr. Diego:

That was Harry Harlow’s study.

Judy:

Yeah, Harlow’s monkeys, because the monkeys really liked the fuzzy little fake people. They weren’t real humans but they were covered in terry cloth or something, and they liked those but not the metallic ones.

Dr. Diego:

Yes. It reinforced their actual sense of touch because it was more of a similar feeling to what the skin would be, as well as in temperature because it wasn’t that cold wire mesh.

Judy:

And have they shown that babies in orphanages who are not touched enough, you know, they are not cuddled and snuggled, is their psychological development retarded because of that? Or is that not truly known?

Dr. Diego:

The children, especially in the Eastern European orphanages, such as Romanian orphanages that we see very little stimulation outside of their necessary needs of food and shelter, they developed very strong problems. You can even see some very dramatic difference in their brain development. And one of the ways that touch can help is there have been experiments that looked at stimulating the touch receptors in animals while they’re going through the early stages in development, and it’s been shown that it actually improves not just their growth and their behavior but also the actual development of their brains.

Judy:

I can totally believe that. That makes perfect sense to me. In a more medical vein, there seem to be many kinds of what I would call healing touch, from the simple, if often neglected, laying on of hands by doctors and nurses to what seems to me like a bewildering array of therapies, from massage in all its different incarnations to Rolfing to Feldenkrais, etc. I don’t even know all the names. Can you tell us what evidence there is that touch can actually heal? Dr. Findley, why don’t you start with that one?

Dr. Findley:

Well, there are now thousands of articles having to do with therapeutic effects of massage. And fortunately, there are researchers who do research on the research, so they’ve collected many of these articles and tried to look to see what the common results from studies on massage are. And pretty clearly, massage reduces anxiety. It improves negative mood; improves pain; seems to increase the way the body handles the cortisol levels in the blood as a response to stress; lowers blood pressure, lowers heart rate. And actually the effect on depression is fairly close to that seen by psychotherapy. So it’s a fairly substantial effect in multiple areas.

And this is separate from whether massage helps a patient with a hurting left knee, for instance. These are the more global effects of massage. So clearly there are some healing effects going on that affect the whole body, as opposed to just a local area of the body.

Judy:

My experience - and actually I have quite a lot of experience of massage, I love it - the effects wear off pretty quickly. A day or so later, all those feel-good vibes seem to be gone. Is that typical or is that unusual?

Dr. Findley:

Most of the studies here actually show some longer term effects. And I think the studies on the infants also show that.

Judy:

Okay.

Dr. Diego:

If I may add some to that, one of the things that studies have been showing is that while there are some prolonged long-term effects while the treatment goes on, across weeks or months it appears that in order to maintain the benefits, there has to be some continuation of the treatments. Just in the same way as if you were taking some medicine, you need to keep taking it to maintain its benefits after a long period of abstinence.

Judy:

Why would massage, why would just stimulating these mechanoreceptors in the skin - why would that make your cortisol and your blood pressure go down and your mood go up? Why would just touching skin help? Aaron LeBauer, do you want to jump in here?

Mr. LeBauer:

Sure. You can’t underestimate the power of touch by another person. And sometimes I think it can’t be measured, or it’s very difficult for a person to measure someone else in their presence, and their healing presence.

Judy:

But that could be true of psychotherapy, too. What’s special, what’s added about touch that’s not there just with a sympathetic listener or nice person?

Mr. LeBauer:

In my experience as a therapist, there are some things that you can’t talk about. When you have your hands on someone and you’re with them - in their muscle, in their tissue, the connective tissue that’s tight - and you’re allowing that to let go, they can sometimes have profound experience of release and letting go. And sometimes that’s what they need to heal, and it’s the brain reorganizing, possibly, to recognize that area of the body that’s being held tightly. Those kinds of things, I think, are hard to find in research articles myself, those intangible aspects to massage and touch.

Judy:

But of course medicine and insurers like to nail it down, nail some of those intangibles down in order to pay for it, to make sure it’s, “real.“ But I’d like to go back to all the different kinds of healing touch. Dr. Findley, can you run through the list for us? What’s massage? What’s Rolfing? What’s Feldenkrais?

Dr. Findley:

Well there are, as you have pointed out, a wide variety, and within any variety there are different schools. For instance, there are 16 schools that teach a variant of structural integration or Rolfing, and they’re all similar but they’re all variant. And needless to say, most people could get easily confused by what they are. I find it easier, rather than to classify them by specific name of therapy, to talk more about the depth of tissue. Some are very superficial; there’s actually one kind of treatment called therapeutic touch, which actually isn’t direct contact on the skin at all.

Judy:

So what is it?

Dr. Findley:

It’s very close contact, but they don’t quite touch.

Judy:

Is that sort of like the Chinese thing of chi, and trying to manipulate the other person’s chi or vital energy without actually touching them?

Dr. Findley:

That’s right. And then there’s the whole range. I think probably the Rolfing structural integration is generally acknowledged to be the deepest. You’re digging with your elbows, or whatever, very deep into the tissue. And then there are a number of techniques in terms of what direction you go on the various muscles. Sometimes you go with it, sometimes you go across it. Sometimes you go from the end of the extremity up to the shoulder, and sometimes you go from the shoulder down to the fingers. There are different techniques, and each of the therapies picks from these techniques and puts them together in a different package.

Judy:

So when I get massage I get what they call deep tissue massage, and it’s really deep and it hurts, but it does sort of loosen things up. How is that different from Rolfing?

Dr. Findley:

The biggest difference there is the goal of the treatment. The Rolfing structural integration is designed to change the way you move when you get up from the table, which is different from just trying to relax a part of the body while you’re lying on the table. So the practitioners are trained somewhat differently. The technique may look similar, and it is quite similar to some of the other body work techniques, but the goal is actually quite different.

Judy:

And then what’s Feldenkrais?

Dr. Findley:

Feldenkrais is a movement exercise that actually is designed to achieve some of the similar changes in movement that Rolfing achieves, except in this case they don’t actually have to put the hands on. They’re just encouraging you to move and guiding you into moving in a different pattern.

Judy:

I’ve also had Thai massage, which is different still. In that kind of massage the therapist kind of stretches you. It’s almost like the person doing yoga with you. They’re moving your body so you just sort of lie there, but they actually get you into these kind of extreme stretches that don’t hurt, and it’s certainly not burrowing deeply into your tissue, but it does kind of stretch things. Have I got that basically right?

Dr. Findley:

Right. And some of these therapies actually, instead of just stretching you, actually have the person move actively back and forth a bit as the therapist is applying the pressure.

Judy:

Yeah. Aaron LeBauer, I want to tell you, first of all, that I really do love massage and I feel like I’m kind of a connoisseur, and I actually feel that you can tell the difference from the first moment that a massage therapist touches you whether that person is really good. Tell us what you’re experience is as a therapist and if you can sort of zero in on a person’s body right away.

Mr. LeBauer:

Right. Yes, I think it’s all about your level of depth in engaging the muscles, the tissues, and the other person. There’s a lot to being, calm and still, and when you engage the other person, sort of connecting with their body and their energy. I think if what you’re asking is how to tell if the therapist you’re going to go see is a good therapist, the best way is word of mouth. You can’t really tell, though.

You can tell as soon as they start to touch you, and I think it’s all about engaging the other person, engaging the depth of the muscle and into the barrier of tissues.

Judy:

Yeah. I truly think you can tell right away who’s good or who’s not. I have to tell you guys, I had a terrible massage once in Ireland by a guy who just didn’t know one muscle from another. And I said, “Can you get this muscle?“ and he didn’t know where it was. He was working so hard he was actually sweating, drops of sweat dropping onto my body. I just eventually ended the massage and got up. You usually never want massages to end, and this one was just horrible. It’s such a wonderful thing but when it’s bad it’s terrible.

I wanted to know, beyond the very strong anecdotal evidence for massage and the popularity of it, what does the science actually show? Miguel, do you want to take that one? Are there big studies showing effectiveness for different types of massage?

Dr. Diego:

Well, the whole field of research in massage in the modern sense is very recent. It’s only a couple of decades old, and there’s been an explosion of studies that are just beginning to come out and be put together to make some sense of it all. One of the things that we’ve seen is that there are some consistent changes across the board on some psychological symptoms, like stress and anxiety, that are reduced. There are also some physiological changes such as increased parasympathetic nervous system activity and a relaxation in stress hormones, as well as perhaps the production of endorphins and reduction of pain.

And when you look at all the different findings, and I’m just mentioning a few of them, it looks like massage could be of benefit for everything. But it’s not that massage is, for example, a panacea that cures everything but rather that it’s acting on certain areas of the body that are common to a number of conditions. So, for example, by increasing parasympathetic nervous system activity, which is increasing more of the relaxation response in the body, you might be promoting the body to have a better immune system, to have more of a relaxed state of mind, decrease anxiety and at the same time even lower pain sensitivity.

Judy:

But has this actually been proven?

Dr. Diego:

Yes, there are studies that are already beginning to show this. There’s research that, as time progresses, becomes better and better conducted and has larger samples. But already the smaller studies are showing that there’s a substantial decrease in psychological symptoms. And one of the interesting things that we’re seeing is that what seems to be important, more than the specifics about one type of treatment or the other, is whether there’s pressure applied to the skin. Because there are studies that show that if you have just very light kind of brushing over the skin without the actual pressure, you don’t get the physiological response.

Judy:

I could believe that. My only other bad massage in my whole life was just like a very light skin rub. It was so disappointing. It didn’t do anything. I can totally believe that you have to get a little bit deep in there.

It’s obvious that massage is extremely popular. Even as of 10 years ago, according to what I’ve read, Americans made 114 million visits in that year alone to massage therapists. That’s a lot of visits. Why, Dr. Findley, and then Miguel and Aaron, why do you think massage is so popular, especially if the scientific evidence for efficacy is not quite there yet?

Dr. Findley:

Well, massage has been part of medical therapeutics for thousands of years. And if you go back to some of the traditions in Indian and Chinese medicine, massage is part and parcel of it.

Judy:

But not really Western medicine. It doesn’t have that same history in Western medicine, does it?

Dr. Findley:

That’s right. Western medicine kind of missed the boat. But the Western patients didn’t miss the boat.

Judy:

Right.

Dr. Findley:

So they’ve been kind of voting with their feet and saying, We think this stuff is working, and that’s why we keep going.

Judy:

Miguel, would you agree with that?

Dr. Diego:

Well, yeah. It actually was a very important part of Western medicine in Greek and Roman times, and just with the introduction of the Dark Ages and the Inquisition it became very much of a part of folk medicine instead of the normal medical establishment. But I think that the main reason why it’s such a popular treatment is because, one, it feels great, and the contraindications are almost negligible. And the potential for getting some benefits out of it are, I think, what drives people to try it.

Judy:

But, Aaron LeBauer, it probably doesn’t work equally well for everybody. I know my husband, I would send him to massage and he would come back saying, you know, What was that all about? It didn’t really do anything for him, whereas I swear by it. There must be people who are more and less receptive to the whole thing. Is that true?

Mr. LeBauer:

Yes. And I think it’s a societal type of view of what massage is. People that get the most out of it view it as part of their well-being and healthcare. And then you have people who do it for enjoyment and for a spa day. The most important thing is the patient or client has to be ready to receive the massage, or they don’t get a lot of out of it because they’re not ready to receive it.

Judy:

Well, wait. What do you mean by “ready to receive it“? Do you mean sort of in the mood for a massage?

Mr. LeBauer:

You have to want to get it. If someone’s husband or someone’s wife makes them an appointment and they go and they’re kind of skeptical about it, they’re not going to get a lot of the benefits out of the massage that they would get if that’s what they had wanted to do in the first place because they thought it was going to help them.

Judy:

Well, doesn’t that make it sound kind of like it’s a big placebo effect?

Mr. LeBauer:

In a way, yes. However, there’s not a lot of research for a lot of the physical therapy modalities that are being practiced today and they’re still being practiced. There’s not always research for what works.

Dr. Diego:

One of the interesting things with massage that we’ve looked at with premature infants is that while these babies have no expectations for receiving any benefits from this therapy, they actually show great improvements in their health outcomes, including weight gain. But one of the things that’s interesting as well is that you don’t see all of the babies responding to the massage across the board. There are some that respond great, and some that don’t seem to show any benefits. And that might have to do with perhaps even some genetic differences between us. I mean, there are differences in the level of touch sensitivity that there are between people, and some people are very touch averse. So that might have something to do with it.

Mr. LeBauer:

Judy, I also believe that there’s a different type of massage or body work that’s going to work best for the individual. The person may not be at the right place for them, so there are different therapists and different types of massage and body work available.

Judy:

Why would you think that gently massaging a preemie baby would help them gain weight? What would be the theoretical explanation for that?

Dr. Diego:

That’s pretty much the area we’ve devoted most of our time researching, and we’ve almost begun to map out the whole mechanism, where by stimulating the receptors of the skin, you’re creating an increase in parasympathetic nervous system activity that we’re enabled to record. And this is translated into increases in gastric activity and the release of food absorption hormones. And when you’re going through this parasympathetic system activity you’re actually going from a state of fight-or-flight to a state of rest-and-digest, where you’re able to actually take those nutrients that are available to you and put them into long-term storage. This is one of the main problems for preterm infants - that they have very low body fat and they need to actually increase their rate of absorbing the nutrients that they receive.

Judy:

And anybody could do it; it doesn’t have to be the mother. I mean, a nurse or a volunteer or someone else could do the massage and the infant would still gain weight?

Dr. Diego:

That’s what we’ve seen. Actually, when we’ve even looked at grandparent volunteers doing the massage we’ve seen that the volunteers are actually getting a very strong decrease in anxiety from doing the massage on the babies.

Judy:

The volunteers benefit?

Dr. Diego:

Yes.

Judy:

Oh, that’s cool. That’s great. So Aaron LeBauer, as a massage therapist, do you feel better after doing a massage? Does it help you?

Mr. LeBauer:

Does it help me giving the massage?

Judy:

Yeah.

Mr. LeBauer:

Some days it’s wonderful. Some days it can be draining, but those days get less and less with the more experience I get.

Judy:

Well, that’s nice to know it’s sort of reciprocal. Maybe the massage therapist should pay the patient instead of the other way around.

Dr. Findley, most massage therapists that I’ve talked to, they all tell you that massage works by increasing circulation to the muscles. Is that true?

Dr. Findley:

Yes, it is likely true, but there’s likely to be more mechanisms than that involved as well.

Judy:

Well, if that’s true - Aaron, this is for you - why would massage be any better than putting on a heating pad or sitting in a nice, hot Jacuzzi? If all you’re trying to do is bring more blood to the muscles, why massage instead of a heating pad?

Mr. LeBauer:

Well, heat can only go so deep. The heating pad and the heat in a Jacuzzi doesn’t go very deep. Your hands can go really deep and affect deeper tissue. But I think, as Dr. Findley said, there are many more benefits to massage than just promoting circulation.

Judy:

Okay. Another benefit that I’ve had massage therapists tell me is that supposedly it releases toxins from the muscles. Dr. Findley, are there really all that many toxins sitting around in the muscles anyway? And how, mechanically, would massage release these?

Dr. Findley:

As far as we know, the major toxins sitting in muscles are really metabolic byproducts from using the muscle too much and a byproduct of stress, and that’s really lactic acid.

We don’t know much about the microscopic levels of toxins. It’s something that - there’s a huge void in research. I don’t know whether, Miguel, you’ve got any information on that, but I certainly haven’t been able to find very much on that.

Dr. Diego:

We haven’t really studied lactic acid and particular muscle functions, but I’ve seen research that’s somewhat inconclusive. In some studies there’s a decrease in lactic acid following massage and in others there is not. So my gut feeling is that the benefits towards muscle recovery, for example, are probably somewhere else, maybe through the release of growth factors by actually stimulating the muscle.

Judy:

And massage therapists also tell you that the massage kind of gets rid of knots in the muscle. Are there really knots in muscles? It’s hard to believe things are actually tied up. Aaron LeBauer, is there such a thing as a knot in the muscle, and how does massage get rid of it?

Mr. LeBauer:

My understanding of knots in muscles - they’re called different things. You can call them trigger points. You can call them tight spots in the back, or knots. And it’s either a chronically elongated or chronically shortened tissue that’s working too hard that then just becomes hypoxic, which has low blood flow, no oxygen. And then you tease out these knots and they feel really good to press on because it stimulates this area that’s being chronically held.

Judy:

So it brings the blood there and gets oxygen.

Mr. LeBauer:

In a way it brings the blood there. Doing therapies like Rolfing and myofascial release, you can release the connective tissue in that area and allow more nutrient flow as well as a release of that tissue, and then work in other areas and allow the muscles not to have to work as hard.

Judy:

Okay. Well, since you brought up the whole issue of myofascial release - Dr. Findley, I wanted to ask you. I know you were an organizer of a conference coming up in Boston on fascia. I think a lot of people, at least lay people, have never even heard of the term “fascia“.“ What is fascia?

Dr. Findley:

Fascia is the tissue that connects everything in the body. It surrounds all the bones. It surrounds the nerves. It surrounds the blood vessels. It surrounds the muscles. But for those of you who are steak eaters, it’s the gristle around the outside of the steak that you can’t eat.

Judy:

I was just going to ask you if it’s like the gristle layer. I mean, if you were a surgeon and you opened people up, you can actually see the fascia.

Dr. Findley:

That’s right. And in most anatomical studies, and if you look in the anatomy books, they remove the fascia. They’re not interested. They take it away and show you what else is there. But if you were to take away everything except the fascia, you would have an exact replica of everything in the body.

Judy:

So is this fascia tissue thick, or is it about the thickness of, say, a fingernail? How big is the stuff?

Dr. Findley:

It varies depending on where it is. In some places it’s a very thin fibrous membrane. Those of you who have taken the skin off a chicken drumstick, there’s just a thin, filmy layer in there; that’s fascia. But when you have people work on your foot, there’s fascia there too, and that’s a very thick, tough fascia.

Judy:

Is it made of collagen?

Dr. Findley:

Yeah, it’s collagen. And there are about 12 different kinds of collagen, and depending on the mechanical nature of the fascia there’s a different proportion of the collagen layer in each fascia.

Judy:

Well, if it’s been kind of ignored by these illustrators of medical textbooks and even by doctors, why is it coming to the fore now? Why is it important? What does fascia actually do in a body?

Dr. Findley:

Well, that’s a good question, and we’re just learning the function of fascia. And maybe I can give an example. There are a number of cells in the brain called glial cells, which - when I was in medical school we were taught they’re just there to support the brain cells. They take up space.

Judy:

Glue cells, they’re called.

Dr. Findley:

Glial cells, right.

Judy:

Yeah, but I mean, lay people call them the glue cells.

Dr. Findley:

Right. The glue cells. Well, it turns out they actually store memory. They contact the cells. They’re very actively involved in the brain. They’re not just sitting there back on the sidelines, and we know that now. And so I think the same thing we’re going to find with fascial structures is they actually are very importantly involved in the body. For instance, one of the findings that are going to be presented at our conference is - we think of muscles as, There’s a muscle and a bag of fascia and there’s a tendon at each end. Pull on one end and it pulls on the other. That’s not the way it exists. We find now that if you pull on one end, about half that force goes out sideways to the fascia, and only the other half goes to the other tendon at the other end. So the fascia forms a major load-bearing function in the body to carry forces between muscles and between joints in ways we’re just understanding.

Judy:

So it must be full of all sorts of chemical signals, and it must be sort of an active tissue.

Dr. Findley:

That’s correct. It’s definitely an active tissue. And that’s part of what this conference is all about, is how do cells respond to pressure. How does that pressure go from the skin all the way down to the cells and into the nucleus of the cell?

Judy:

So all mammals have fascia. We’re all - evolution put it there for some reason. It must be of some benefit to us because we’ve all got it.

Dr. Findley:

That’s right.

Judy:

Aaron LeBauer, why does it hurt so much when a massage therapist digs into the fascia tissue? I know there’s a so-called runner’s band, the iliotibial band on the outside of your thighs, and if you jog a lot that gets very tight and then when it gets massaged it really hurts. Why is it so painful?

Mr. LeBauer:

That’s a good question.

Judy:

Well, what’s the answer?

Mr. LeBauer:

Well, the IT band has very little on top of it, and it’s very tight, and it’s a very tender area.

Judy:

I see. It’s like there’s not much muscle or fat to absorb the pressure of the massage.

Mr. LeBauer:

No, not at all. And then there are areas that hurt and there are two kinds of hurt. There’s a good hurt and a bad hurt.

Judy:

I think that’s really true. But the fascia is kind of a bad hurt.

Mr. LeBauer:

Well, it’s a good hurt if it’s a healing hurt, if it’s a healing touch, if it’s a therapeutic pain, that type of pain. Any more than that, if it’s a bad hurt, I don’t do that type of hurt, and I try to talk to my patients and clients about not letting me do an injurious pain to them.

Judy:

Okay.

We have an e-mail that’s come in. This one is from Jenny in San Diego. She writes, “Does Rolfing hurt? I’ve heard it’s very painful.“ Dr. Findley, why don’t you take that one?

Dr. Findley:

Well, I had my first Rolfing session in 1970, many years ago. And it really hurt. There’s no question about it. It was really painful. And I went back for another one because I liked the results.

Judy:

What were the results?

Dr. Findley:

I felt better. I could move better. I could touch the floor with my fingertips, and by the time I was done I could get my hands on the floor. And I moved better than I had for as long as I could remember. And then I had a session from somebody else, and it didn’t hurt at all.

Judy:

So was it the skill of the practitioner that was different or were you kind of softened up?

Dr. Findley:

She had developed a technique that didn’t hurt very much. And I tried to tell her, “You need to teach everybody else this technique.“ So by now most of the people doing it have learned a little different technique, and it’s not nearly as painful as the reputation is. I’ve actually had patients of mine fall asleep when I’m working on them.

Judy:

Well, what is actually the difference? What is the, “good“ Rolfer doing that the painful one didn’t do?

Dr. Findley:

Well, the easiest way to describe it is if you push hard enough on a tissue, it’s going to give up and you can then work through it and stretch it out. But it’s much easier on me, and it’s much easier on my patient, if I coax it into relaxing rather than overpowering it.

Judy:

So what is it about Rolfing that does make it hurt? You’re just kind of pushing on nerve cells? Or what actually is the cause of the pain?

Dr. Findley:

If you were to take a paperback book and drop it in a bucket of water and let it dry, it’s like a brick. There’s no flexibility to it. But if instead you separate the pages as it’s drying, it’s almost as good as new. And so Rolfing takes the same kind of approach to the body as to take those layers of fascia and separate them a little bit so they start to move on each other, and that can be painful, as you’re essentially pushing fluid down in between the two layers to separate them a little bit.

Judy:

I see. I’ve actually read - and this may sound a little bit offbeat to you - that researchers in Vermont believe that acupuncture actually works kind of by sending chi, that vital energy as the Chinese call it, along the fascial planes in the body. Is there any truth to that?

Dr. Findley:

Well, that researcher is actually Helene Langevin, who is going to be coming to the fascia congress. And what she’s showing with acupuncture is that indeed as you twist the acupuncture needle, you are essentially tugging on the connective tissue.

Judy:

The needles don’t go very deep, though?

Dr. Findley:

Well, the connective tissue goes everywhere in the body, so they don’t have to go very deep in order to grab the connective tissue. And what she’s saying is that the connective tissue is a signaling mechanism. Chi is a Chinese term that doesn’t really have any Western definition, so we’re kind of stuck here between two sets of languages. But what she’s saying is that the connective tissue gets stimulated and those nerve impulses then go into the nervous system and then create a change. Which is a Western way of saying chi.

Judy:

But we don’t have a Western explanation in terms of the needle twists in the fascia that release endorphins or release some other neurochemical that then lands on another receptor. We haven’t gotten it that mechanistically yet. Is that right?

Dr. Findley:

That’s right. We haven’t gotten that far yet.

Judy:

Another question for you, Dr. Findley. I’ve read that in your own practice you worked on the late actor Christopher Reeve. Is that true? And can you talk about that a little? What did you do for him, and did it help?

Dr. Findley:

Yes, actually I can talk about him, because he actually acknowledged me in his autobiography and explained it a little bit, so I can go in a little more detail. I was actually director of research at the Kessler Institute for Rehabilitation when Christopher Reeve came in. And he was on the ventilator for quite some time. His physicians thought that there was a way to get him off, but nobody could do it. So they came to me and said, Could you design a way to get him off the ventilator? He had very little muscle function. He was a high cervical quadriplegic.

Judy:

Just for our listeners, the ventilators were because he lost control of muscles in his chest that would allow him to breathe.

Dr. Findley:

Right. In other words he broke his neck and most of the muscles below that area couldn’t move. He could, however, wiggle his big toe, so the neck wasn’t completely severed. So there was a little bit of connection getting through. When I first saw him and we were able to measure how much he could breathe, he could inhale about 50 cc’s.

Judy:

That’s very little.

Dr. Findley:

That’s very little. That’s like a quarter of a cup. And we were very limited in what we could measure, but we said, Okay, at least there’s something moving. Now, when you and I are sitting here breathing at rest, we’re breathing 500 cc’s, so 50 cc’s is a long way from being to breathe.

Judy:

Right. He wouldn’t get enough air that way to maintain himself.

Dr. Findley:

No. No. So I had to figure out ways to stimulate the muscles that he could use and to make it easier for his chest to move. So essentially I used the Rolfing procedure both to activate the muscles and to release some of the connective tissue around his chest so that he would be able to breathe more.

Judy:

And I assume since he was paralyzed that this wouldn’t have hurt at all. Is that right? He wouldn’t have felt it.

Dr. Findley:

That’s right. That’s right. He didn’t have any sensation - actually, he had some sensation in the mid-chest, so he felt some of it. But, no, the technique I was using wasn’t painful.

Judy:

So did it work?

Dr. Findley:

We got him so he could breathe on his own for 45 minutes.

Judy:

Wow. And you attribute that solely to the massage or the Rolfing?

Dr. Findley:

No, we used - I mean, I used every trick in my book I could find to try to get him to do that. But I think the Rolfing was an important part in loosening up the chest so his very limited muscle could move it.

Judy:

What were the other tricks? Did you have electrical stimulation of the muscles?

Dr. Findley:

We didn’t do electrical stimulation, but we positioned his body in a way that the muscles wouldn’t have to move so much. Muscles work better at a certain length, so you have to adjust them so that they’re just at the right length so that they can move maximally in that ability. And then, of course, he was very anxious, needless to say.

Judy:

Well, of course. Yeah.

Dr. Findley:

Yeah. So we had to deal with the anxiety. And when you’re anxious you can’t breathe very well, so that didn’t help.

Judy:

That’s right.

Dr. Findley:

So basically, we put an earlobe monitor on for his oxygen tension, and I said, “Any time you’re over 86 percent oxygen saturation you’re fine, you’re not going to die. So do whatever you’re doing and keep it above that.“ And with that then as a feedback mechanism, we could go gradually, you know - one minute, two minutes, five minutes, ten minutes.

Judy:

So he could see that.

Dr. Findley:

He could see that. He could see he must be doing okay. And then he didn’t worry.

Judy:

That makes me wonder about people with asthma. You know, has this Rolfing stuff or deep massage been able to help people who can’t breathe because of asthma?

Dr. Findley:

Yes, actually there are some studies on massage and manual therapies for asthma. Again, there’s not a lot of data on them, but there are some studies that have indicated it can be helpful.

Judy:

Aaron LeBauer, do you know - does that also help for people with asthma or breathing difficulties in general, maybe emphysema or something?

Mr. LeBauer:

I’m thinking, and I know there are some studies that have shown your lung function can improve through manual therapies and myofascia release. It will improve your lung volume, but mostly that’s for opening up the lungs and the posture. But with asthma and other chronic, obstructive diseases, you’re breathing with your accessory muscles, and then your rib cage can lock down. And if you can unlock the rib cage and allow the ribs to expand more and get the diaphragm in a better position so that it can work more efficiently, then you can certainly help people breathe deeper.

Judy:

Miguel Diego, what do we know about massage for people with chronic fatigue? We just had a show recently on that, and obviously that affects a lot of people. Is there any evidence that any of those massage therapies work for that?

Dr. Diego:

That I know of, there’s only been one small study that looked at massage for chronic fatigue, and there was some improvement in some of the symptoms associated, including psychological as well as lower fatigue and better physical states. But it’s still an area that needs to have a lot more research conducted. There are some studies that have looked at other chronic conditions, such as chronic pain conditions, and they seem to show that massage does have a benefit for those conditions. But it’s still a very young area.

Judy:

Yes, I can imagine. I know there was a pretty famous case of a pianist, Leon Fleischer, who had to stop playing after a really terrific career, for 30 years, and then apparently he was able to resume playing. Dr. Findley, was it Rolfing that helped him or was it botulism injections? What do you know about it? His condition, I guess, was dystonia. First, tell us what that is and what you think got him better.

Dr. Findley:

Dystonia comprises a number of conditions that get lumped into the same term. And dystonia just means that the muscle has more tone that it should. In his case it was local, just one arm, it wasn’t over the whole body. It was just one arm that was dystonic. Sometimes you see that with someone who has a facial gesture like a tic, and in his case, rather than just an occasional contraction, the muscle was constantly contracted.

Judy:

Kind of like a spasm of some kind?

Dr. Findley:

Kind of like a spasm that never gave up, yeah. Imagine you’ve got a charley horse that doesn’t quit; that’s what his arm was doing.

Judy:

That must hurt.

Dr. Findley:

Yeah. So after it’s been doing that for a while, there are obviously multiple changes within the muscle and connective tissue, so that even if it were to relax, the arm wouldn’t be normal.

Judy:

I see.

Dr. Findley:

So he wound up going to a Rolfer for a very large number of sessions. I think we’re talking over a hundred sessions to try to get that tissue loosened up so it could start to move. And then he got the Botox injections, which actually blocked some of the nerve impulses into the muscle, so that even while the brain is trying to tell the muscle to contract, the muscle just won’t contract quite so hard. So between the two of them, he was able to loosen up his hand enough that he could then play two-handed pieces.

Judy:

That’s amazing. That’s totally amazing. We actually have a lot of listeners with chronic diseases, including MS, multiple sclerosis. Aaron and Miguel, what symptoms of MS might massage help with? And do you know of any actual evidence for this? Does massage help with MS?

Dr. Diego:

It would definitely help with some of the symptoms associated with quality of life by taking care of some of the psychological things that go along with MS, such as depression. And it would also alleviate perhaps some of the pain and maybe even improve some aspects of functioning.

Judy:

And is there actual evidence for this?

Dr. Diego:

I think it’s very limited still. The problem has been that there has been very limited funding for research on massage. And this is why we see such a void in our knowledge of this area.

Judy:

Yeah, it’s really a shame. Aaron, do you want to add anything to that?

Mr. LeBauer:

Sure. I treated a patient with MS about a year and a half ago who was wheelchair bound. And once you’re wheelchair bound, you’re in the same position the majority of the day, so there’s a lot of things comfort-wise and pain-wise associated with just being stuck in one position. And as the muscles and joints and bones no longer move, the fascia can become bound down, so just unlocking some of that can provide more movement, more pain relief from the secondarily associated symptoms of not being able to move through a full range of motion.

Judy:

I want to ask you all about cancer patients, not just using massage to relieve anxiety and depression, as important as that is, but for a condition called lymphedema, which often strikes women who have had breast cancer and who have had all or most of their lymph nodes in their armpits removed. Often they end up with a very swollen arm on that side and kind of stagnant lymph fluid. What does massage do for that, and is it a specific type of massage? Dr. Findley, do you want to start with that one?

Dr. Findley:

There actually is a very specific massage to relieve lymphedema which basically starts at the end of the extremity and essentially pushes the fluid up toward the heart.

Judy:

So you kind of squeeze it up?

Dr. Findley:

Yes, that’s right.

Judy:

And what does that actually do?

Dr. Findley:

Well, the way our bodies are designed, the blood vessels, the arteries, carry the blood out and then it goes back in the veins, but they’re leaky. So fluid leaks out from both the blood vessels and the veins into the extracellular space. And that fluid then moves up through the lymph space, and there’s a whole circulatory system that then puts it into the superior vena cava where the lymph flows in there.

Judy:

It’s kind of like a second circulation.

Dr. Findley:

Yeah. We don’t know too much about what powers the lymph flow, but typically we think it’s muscle contractions. We know it sends blood up the veins and it probably also sends the lymph fluid up so that as you get pressure it goes one direction but it doesn’t go back. So that’s the whole idea behind the special kind of massage for lymphedema, is you put pressure on the outer end of the arm and you’re gradually pushing the fluid up, and it’s not going to go back to the end of the extremity.

Judy:

That’s very interesting. Miguel, what about for people with HIV; do you know of any data on whether massage helps, not just with psychological stuff but with any of the immune parameters?

Dr. Diego:

That I know of, there have been three studies, actually maybe four studies that have looked at people with HIV, and there have been a couple of studies with other immune deficiency populations, such as breast cancer survivors. And one of the things that they’ve seen is that there’s some improvement on measures such as CD4 [lymphocyte] counts. It appears that some of the effects of the massage have to do with stimulating a cascade of events that might involve reduction in stress hormone levels that tend to have a negative effect on our immune system. So in this way they can actually increase immune function in people who are immune deficient.

Judy:

Okay. And what about - again, for you, Miguel - is there any research about massage for conditions like fibromyalgia or migraines, or juvenile rheumatoid arthritis?

Dr. Diego:

Yes. There have been just very few studies, but they all point out to a reduction in pain. And reduction in pain might come from several different factors. It could be as simple as the pain gauge mechanism, where the sensation of touch being administered by the massage is competing with the pain signals, so it’s blocking the pain from going to your brain. Or it could come from the release of the natural pain killers in your body, which are the endorphins, or perhaps through some other mechanisms. And there’s some evidence that there’s an increase in endorphins when you do massage, as well as perhaps some anatomical evidence that shows that the fibers that would be stimulated by massage - normally, the pressure receptors - would actually be able to override the signal from the nociceptors, which are the receptors for pain.

Judy:

Yeah. This is for all of you or any of you - are there times when people should not get massages? For instance, if you’re just coming down with a cold or if you’ve got some other active infection, would massage under those conditions actually make something worse? Dr. Findley, do you want to start?

Dr. Findley:

Well, basically if you have an infection in an area you probably don’t want to be pushing on it, moving the infection around. But working close to it to improve the circulation is probably a good idea. And if you have a broken bone you probably don’t want to move it around. But beyond that, beyond those really obvious things, it’s kind of like chicken soup. It’s kind of good for most everything.

Judy:

Okay. It certainly sounds wonderful to hear you all talk, and from my own experience I can certainly endorse it. We are just about out of time. Dr. Thomas Findley, any last thoughts you’d like to leave us with tonight?

Dr. Findley:

Well, I guess I should tell you to go out and find your local massage therapist and go enjoy it.

Judy:

That’s a great parting thought. Aaron LeBauer, what about you? What would you tell people?

Mr. LeBauer:

I would just say massage not only feels good, it’s good for you.

Judy:

That’s great. And Miguel Diego, what is your final thought?

Dr. Diego:

Well, definitely that there are a lot of benefits that are becoming clear when we begin to see some of the findings from research. And on top of that, you have a technique that you really can’t beat the sensation and the feeling that you get from it. So there’s really no reason not to go ahead and get a massage.

Judy:

Well we’ve talked tonight about the psychological benefits and the physical benefits and basically the almost virtual lack of harm from massage. It’s essentially good for what ails you. And it seems, from what you have all said, that Western medicine is at long last catching on to this.

I would like to thank all of my guests tonight. And I would like to thank you, the listeners, for joining us. Until next week, I’m Judy Foreman. Good night.